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Jackson SL, Olson DE, Mohan A, Tomolo A, Barb D, Dubowitz N, Watson-Williams P, Ownby J, Rhee M, Phillips LS. Who is missed by A1c screening for diabetes? Poster session presented at: American Diabetes Association Annual Scientific Session; 2012 Jun 8; Philadelphia, PA.
Although there is increasing use of A1c screening to detect previously unrecognized diabetes, the characteristics of people with diabetes who are missed by A1c screening are unknown. To study this problem, we combined two datasets, one of veterans and another of the general population, where subjects had both OGTT and A1c assessed. We examined screening by ADA (A1c > = 6.5%) and VA (A1c > = 7.0%) criteria for diabetes. The 2329 subjects were 59% male and 63% black, with average age 51 years and BMI 30. Of the 6% (n = 145) who had previously unrecognized diabetes based on OGTT, A1c with ADA criteria missed 68% while VA criteria missed 88%. In both groups, A1c screening was more likely to miss whites (both p < 0.01), possibly because of the association of black race with higher A1c, independent of glucose levels. With both ADA and VA criteria, subjects missed by A1c screening had significantly lower fasting (both p < 0.05) and 2hr OGTT glucose levels (both p < 0.01) - implying that they were earlier in their natural histories - but lower glucose levels could not be attributed to having lower age or BMI in multivariate analyses. Subjects missed by A1c screening also had significantly lower LDL levels, blood pressure, and triglycerides (but not higher HDL). However, despite lower glucose and cardiovascular risk factor levels, 99% of those who were missed still had one or more risk factor levels that did not meet ADA guidelines for good care.
